Family Environment's Impact on Attention-Deficit Disorder Studied

Children whose families suffer from poverty, severe marital discord,
and other adversities are more likely than others to be diagnosed with
attention-deficit hyperactivity disorder.

Harvard University researchers drew that conclusion in a study
published in the June issue of the American Medical Association's
Archives of General Psychiatry. Several articles in the journal
focused on hyperactivity, including the use of Ritalin, the drug often
used to control the symptoms of the disorder, known as A.D.H.D.

Both the Harvard research and another study found that Ritalin
worked safely and effectively in hyperactive children with motor and
vocal tics. Historically, experts have disagreed over whether Ritalin
can make such tics worse.

A third article looked at similarities between the effects on the
brain of Ritalin and cocaine.

The family-environment study was led by researchers from
Massachusetts General Hospital and Harvard Medical School. They found
that low social class, living in foster care, large family size, having
a father involved in crime, and having a mother with mental illness
were linked with mental disorders and psychological and social problems
in both A.D.H.D. children and those without the disorder.

The more adversity factors children in either group faced, the more
likely they were to show depression, anxiety, bad behavior, and other
problems.

"We believe that adversity plays an important role in maintaining
and aggravating the precarious balance that A.D.H.D. children may
already have," said Dr. Joseph Biederman, the lead author of the study
and an associate professor of psychiatry at Harvard Medical School.

Researchers studied 140 white, non-Hispanic boys between the ages of
6 and 17 years with A.D.H.D., and 120 boys without the disorder.

Contrary to popular belief, the study did not find a link between
adversity factors and children who repeated grades, had school-based
tutoring, or were placed in special classes.

The researchers said that, because none of the study subjects was in
abject poverty or at other extreme social disadvantage, their findings
suggest that even modest levels of adversity can impair a child's
mental and social well-being.

Understanding the apparent association of adversity with
attention-deficit hyperactivity disorder may help physicians and
educators intervene where they can, said Dr. Biederman. A.D.H.D.
children with family strife may have a harder time than others
responding to medical treatment, he said.

"Certain interventions can provide the opportunity to diminish the
ill fate of A.D.H.D. children," Dr. Biederman said, especially those
methods that, for example, try to improve family relations or help a
mother's depression. But he acknowledged that doctors and educators can
do little about poverty or large family size.

Dr. Biederman cautioned that the study does not show a
cause-and-effect relationship and urged that educators not lay blame
for A.D.H.D. at the family's doorstep.

Rachel Klein, a professor of clinical psychology at the Columbia
University College of Physicians and Surgeons who was not involved in
the Harvard study, agreed. She said causality could not be inferred
from the study and added that a family situation should not be a major
focus of treatment for A.D.H.D.

High school students who use anabolic steroids to build muscle are
more likely than their peers to be "shooting up" other drugs and to be
users of multiple drugs, says a study out this week.

Teenagers who use steroids without a doctor's prescription are also
more likely to use cocaine and other drugs such as amphetamines and
heroin, according to researchers from Harvard Medical School and the
federal Centers for Disease Control and Prevention. Those teenagers are
also more likely to drink alcohol, the study found.

The researchers based the study, published this month in the journal
Pediatrics, on 12,267 responses to the C.D.C.'s 1991 Youth Risk
Behavior Survey. Public and private school students in grades 9 through
12 from the 50 states and the District of Columbia responded to the
questionnaire.

The scientists found that about 4 percent of male students and 1.2
percent of female students reported ever using steroids without a
prescription. Anabolic steroids are synthetic derivatives of the male
hormone testosterone.

Students living in the South were more likely to have used steroids
than students in other parts of the country. And, the study found,
students who perceived themselves to have below-average academic
performance reported higher steroid use.

When school-based health services became part of last year's debate
over health-care reform, experts in the field realized they had no
national group serving their interests.

The rapid growth of the field in recent years has made the need for
such a group increasingly urgent, said Julia Graham Lear, the director
of Making the Grade, a program based at George Washington University in
Washington that supports school-based health centers. Demands for
information and technical assistance have multiplied as the number of
school-based health centers has increased--doubling in the past three
years alone, from just over 300 in 1992 to about 650 this year, Ms.
Lear said.

So, to that end, she and others organized the first-ever National
Assembly on School-Based Health Care, which was sponsored by several
foundations as well as the C.D.C. More than 500 participants from all
over the country convened last month in Washington to discuss topics
such as starting a school-based health center, negotiating the world of
managed care, and how to find funding.

A national membership group was also born at the conference. It
bears the same name as the meeting--the National Assembly on
School-Based Health Care. Participants elected Donna Zimmerman, the
executive director of Health Start Inc., as the group's first
president. The company runs several school-based health centers in St.
Paul. The assembly can be reached at (703) 556-0411.

--Millicent Lawton

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